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New nurse staffing tool for hospitals endorsed by NICE

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A new tool for carrying out advance planning of nurse staffing levels in hospitals has been endorsed by the National Institute for Health and Care Excellence.

The Establishment Genie tool, which has been in development since 2014, allows senior nurses to input and review planned care levels provided by nurses and healthcare assistants compared to the budget available.

“Nurses need to have really good information to counter some quite strong pressure on them to make cuts to staffing”

Richard Cooper

It also allows them to review information including skill mix, the context a ward is typically operating within – such as its number of admissions, average fill rates for nurse shifts and its number of vacancies – and how much annual leave and maternity cover will be required.

In addition, planned staffing levels for different wards can be compared with one another at three different points in a 24-hour period.

Patient outcomes, such as the number of falls and pressure ulcers associated with certain staffing levels, can also be reviewed alongside potential changes to the workforce model.

The Establishment Genie tool was developed by two healthcare management consultants, following discussions with around 30 hospitals in the UK, Australia and New Zealand about how to plan establishments for safe nurse staffing.

“We wanted to give something to nurses to help them hold the line in those difficult discussions [about finance and staffing]”

Richard Cooper

It is one of just a handful of resources that NICE has assessed as being aligned to its nurse staffing guidance for adult inpatient wards in acute hospitals, and was endorsed by the body this week.

It follows NICE’s endorsement of the Safer Nursing Care Tool (SNCT) for acute hospitals, developed by a group of senior nurses in 2011.

However, unlike the SNCT, the Establishment Genie tool does not include patient acuity and dependency measurements. Neither can it be used to make day-to-day changes to rotas.

Those behind the new resource stressed it had been designed to plan for safe nursing establishments in the future in a way that could also be understood by finance and human resources directors.

They added that, as per national guidelines, it should be used alongside nurses’ professional judgement and also other tools and measurements.

“Our tool has come into its own as people are looking at service redesign and how they might staff new areas”

Eve Mitchell

“Nurses need to have really good information to counter some quite strong pressure on them to, perhaps, make cuts to staffing or see where they can make savings,” said Richard Cooper, co-founder of the firm Creative Lighthouse, which created the tool.

“We wanted to give something to nurses to help them hold the line in those difficult discussions, which complements their professional judgement,” he told Nursing Times.

“Our tool has come into its own as people are looking at service redesign and how they might staff new areas or where they are looking at completely new areas of staffing,” said Eve Mitchell, fellow co-founder of Creative Lighthouse.

“For example, we see a lot of intermediate or medically-fit-for-discharge wards that are very much nurse-led, and with many healthcare assistants, that come up with all sorts of ways for working that fit in with new demands.

“So they can use this tool to put in the number of beds, how they are configured and used, and it will estimate the level of whole-time equivalent staffing required,” she added.

“The Establishment Genie resource has been endorsed to use alongside the guideline recommendations on planning establishments in advance”

NICE spokeswoman

Three organisations involved in the piloting phase are currently using the tool – Chelsea and Westminster Hospital NHS Foundation Trust in London, Yeovil District Hospital NHS Foundation Trust, and Royal Trinity Hospice in London.

It is expected that a further five NHS trusts will be using it by the end of May, as well as 11 further hospices.

In the future, it is hoped the tool will be adapted for use in other settings such as care homes and community nursing services.

A spokeswoman for NICE said: “Establishment Genie is endorsed alongside a number of other resources for our safe staffing guideline for acute hospitals.

“The Establishment Genie resource has been endorsed to use alongside the guideline recommendations on planning establishments in advance (recommendations 1.2 and 1.3),” she added.

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